癌症相關輕微認知功能障礙之評估與處置

Assessment and Management of Mild Cognitive Impairment of Cancer Patients

10.6530/YYN.202003_14(1).0001

楊卉穎(Hui-Ying Yang)；孫秀卿(Shiow-Ching Shun)

癌症 ； 輕微認知功能障礙 ； 評估 ； 處置 ； cancer ； mild cognitive impairment ； assessment ； management

源遠護理

14卷1期（2020 / 03 / 01）

5 - 15

繁體中文

癌症相關認知功能障礙發生率高達75%，是癌症病人接受癌症相關治療過程常見且感到困擾的症狀，常影響記憶、專注、執行功能等認知層面，而對日常生活功能與生活品質帶來漸進與長期的嚴重影響。然而，由於其障礙程度多屬輕微而較不易評估、評估工具種類多樣且費時、有效介入措施仍未有一致定論，以及在臨床上醫護專業人員對此相關症狀仍缺乏敏感度，導致提供癌症存活者完善認知障礙的照護上充滿挑戰。本文將藉由介紹癌症相關輕微認知功能障礙之定義、症狀與影響，探討常用之客觀與主觀認知功能評估工具以及目前以實證為基礎之相關照護處置，提供臨床護理人員對於認知功能照護的進一步了解，以增加臨床認知障礙之評估與照護能力。

Up to 75% of cancer patients have cancer-related cognitive impairment, which is the common distress symptom during cancer-related treatment. It generally influences memory, attention, and executive function and profoundly affects patients' daily life and quality of life in short- and long-term. However, it is still a challenge for nurses to offer the cancer survivors with the comprehensive care for cognitive impairment because of being not easy to assess mild impairment, diverse and time consuming assessment tools, controversy for the effective evidence-based interventions, and lacking of attention and sensitivities on assessing cognitive impairment by nurses. Therefore, this article mainly focuses on reporting the definition, symptoms, and its impact of mild cognitive impairment, objective and subjective assessment tools, and briefly summary of evidence-based intervention. It will help the clinical nurses to more understanding care of cognitive function in cancer patients and to enhance the ability to assess and manage cognitive impairment.

1. 李麗紅,陳于群,楊政議(2018)。癌症病人化療後認知功能障礙之照護。腫瘤護理雜誌，18(2)，5-11。
   連結：
2. Aaronson, N. K.,Ahmedzai, S.,Bergman, B.,Bullinger, M.,Cull, A.,Duez, N. J.,Takeda, F.(1993).The European Organization for Research and Treatment of Cancer QLQ-C30- A Quality-of-Life Instrument for Use in International Clinical Trials in Oncology.Journal of the National Cancer Institute,85(5),365-376.
3. Allen, D. H.,Myers, J. S.,Jansen, C. E.,Merriman, J. D.,Von Ah, D.(2018).Assessment and management of cancer- and cancer treatment-related cognitive impairment.The Journal for Nurse Practitioners,14(4),217-224.
4. Asher, A.,Myers, J. S.(2015).The effect of cancer treatment on cognitive function.Clinical Advances in Hematology & Oncolology,13(7),441-450.
5. Bender, C. M.,Thelen, B. D.(2013).Cancer and cognitive changes: The complexity of the problem.Semininars in Oncology Nursing,29(4),232-237.
6. Bray, F.,Ferlay, J.,Soerjomataram, I.,Siegel, R. L.,Torre, L. A.,Jemal, A.(2018).Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries.A Cancer Journal for Clinicians,68(6),394-424.
7. Bray, V. J.,Dhillon, H. M.,Vardy, J. L.(2018).Systematic review of self-reported cognitive function in cancer patients following chemotherapy treatment.Journal of Cancer Survivorship,12(4),537-559.
8. Broadbent, D. E.,Cooper, P.,FibGerald, P.,Parkes, K. R.(1982).The Cognitive Failures Question naire (CFQ) and its correlates.British Journal of Clinical Psychology,21,1-16.
9. Castel, H.,Denouel, A.,Lange, M.,Tonon, M. C.,Dubois, M.,Joly, F.(2017).Biomarkers associated with cognitive impairment in treated cancer patients: Potential predisposition and risk factors.Frontiers in Pharmacology,8,138.
10. Chan, R. J.,McCarthy, A. L.,Devenish, J.,Sullivan, K. A.,Chan, A.(2015).Systematic review of pharmacologic and non-pharmacologic interventions to manage cognitive alterations after chemotherapy for breast cancer.European Journal of Cancer,51(4),437-450.
11. Cheung, Y. T.,Lim, S. R.,Shwe, M.,Tan, Y. P.,Chan, A.(2013).Psychometric properties and measurement equivalence of the English and Chinese versions of the functional assessment of cancer therapy-cognitive in Asian patients with breast cancer.Value Health,16(6),1001-1013.
12. Ciesielska, N.,Sokolowski, R.,Mazur, E.,Podhorecka, M.,Polak-Szabela, A.,Kedziora-Kornatowska, K.(2016).Is the Montreal Cognitive Assessment (MoCA) test better suited than the Mini-Mental State Examination (MMSE) in mild cognitive impairment (MCI) detection among people aged over 60? Meta-analysis.Psychiatria Polska,50(5),1039-1052.
13. Cifu, G.,Power, M. C.,Shomstein, S.,Arem, H.(2018).Mindfulness-based interventions and cognitive function among breast cancer survivors: A systematic review.BMC Cancer,18(1),1163.
14. Coro, D.,Hutchinson, A.,Dahlenburg, S.,Banks, S.,Coates, A.(2019).The relationship between diet and cognitive function in adult cancer survivors: A systematic review.Journal of Cancer Survivorship,13(5),773-791.
15. Deprez, S.,Kesler, S. R.,Saykin, A. J.,Silverman, D. H. S.,de Ruiter, M. B.,McDonald, B. C.(2018).International cognition and cancer task force recommendations for neuroimaging methods in the study of cognitive impairment in Non-CNS cancer patients.Journal of the National Cancer Institute,110(3),223-231.
16. Duijts, S. F.,van der Beek, A. J.,Boelhouwer, I. G.,Schagen, S. B.(2017).Cancer-related cognitive impairment and patients’ ability to work: A current perspective.Current Opinion in Supportive and Palliative Care,11(1),119-23.
17. Fernandes, H. A.,Richard, N. M.,Edelstein, K.(2019).Cognitive rehabilitation for cancer-related cognitive dysfunction: A systematic review.Supportive Care in Cancer,27(9),3253-3279.
18. Hermelink, K.(2015).Chemotherapy and cognitive function in breast cancer patients: The socalled Chemo Brain.Journal of the National Cancer Institute. Monographs,2015(51),67-69.
19. Isenberg-Grzeda, E.,Huband, H.,Lam, H.(2017).A review of cognitive screening tools in cancer.Current Opinion in Supportive and Palliative Care,11(1),24-31.
20. Janelsins, M. C.,Kohli, S.,Mohile, S. G.,Usuki, K.,Ahles, T. A.,Morrow, G. R.(2011).An update on cancer- and chemotherapy-related cognitive dysfunction: Current status.Seminars in Oncology,38(3),431-438.
21. Kim, Y.,Kang, S. J.(2019).Computerized programs for cancer survivors with cognitive problems: A systematic review.Journal of Cancer Survivorship,13(6),911-920.
22. Lange, M.,Joly, F.,Vardy, J.,Ahles, T.,Dubois, M.,Tron, L.,Castel, H.(2019).Cancer-related cognitive impairment: An update on state of the art, detection, and management strategies in cancer survivors.Annals of Oncology,30(12),1925-1940.
23. Li, M.,Caeyenberghs, K.(2018).Longitudinal assessment of chemotherapy-induced changes in brain and cognitive functioning: A systematic review.Neuroscience & Biobehavioral Reviews,92,304-317.
24. Merriman, J. D.,Von Ah, D.,Miaskowski, C.,Aouizerat, B. E.(2013).Proposed mechanisms for cancer- and treatment-related cognitive changes.Seminars in Oncology Nursing,29(4),260-269.
25. Moore, H. C.(2014).An overview of chemotherapy-related cognitive dysfunction, or ‘chemobrain.Oncology,28(9),797-804.
26. Myers, J. S.(2009).Chemotherapy-related cognitive impairment.Clinical Journal of Oncology Nursing,13(4),413-421.
27. Myers, J. S.,Erickson, K. I.,Sereika, S. M.,Bender, C. M.(2018).Exercise as an intervention to mitigate decreased cognitive function from cancer and cancer treatment: An integrative review.Cancer Nursing,41(4),327-343.
28. National Comprehensive Cancer Network (2019). NCCN Clinical Practice Guildlines in Oncology-Survivorship. Retrieved from https://www.nccn.org/professionals/physician_gls/pdf/survivorship.pdf
29. Oh, P. J.,Kim, J.(2016).The effects of nonpharmacologic interventions on cognitive function in patients with cancer: A meta-analysis.Oncology Nursing Forum,43(5),E205-E217.
30. Pendergrass, J. C.,Targum, S. D.,Harrison, J. E.(2018).Cognitive impairment associated with cancer: A brief review.Innovations in Clinical Neuroscience,15(1-2),36-44.
31. Rambeau, A.,Beauplet, B.,Laviec, H.,Licaj, I.,Leconte, A.,Chatel, C.,Joly, F.(2019).Prospective comparison of the Montreal Cognitive Assessment (MoCA) and the Mini Mental State Examination (MMSE) in geriatric oncology.Journal of Geriatric Oncology,10(2),235-240.
32. Seidenberg, M.,Haltiner, A.,Taylor, M. A.,Hermann, B. B.,Wyler, A.(1994).Development and validation of a multiple ability self-report questionnaire.Journal of Clinical and Experimental Neuropsychology,16(1),93-104.
33. Vannorsdall, T. D.(2017).Cognitive changes related to cancer therapy.The Medical Clinics of North America,101(6),1115-1134.
34. Vardy, J. L.,Bray, V. J.,Dhillon, H. M.(2017).Cancer-induced cognitive impairment: Practical solutions to reduce and manage the challenge.Future Oncology,13(9),767-771.
35. Vitali, M.,Ripamonti, C. I.,Roila, F.,Proto, C.,Signorelli, D.,Imbimbo, M.,Lo Russo, G.(2017).Cognitive impairment and chemotherapy: A brief overview.Critical Reviews in Oncology/ Hematology,118,7-14.
36. Von Ah, D.(2015).Cognitive changes associated with cancer and cancer treatment: State of the science.Clinical Journal of Oncology Nursing,19(1),47-56.
37. Von Ah, D.,Jansen, C. E.,Allen, D. H.(2014).Evidence-based interventions for cancer- and treatment-related cognitive impairment.Clinical Journal of Oncology Nursing,18(Suppl),17-25.
38. Von Ah, D.,Storey, S.,Tallman, E.,Nielsen, A.,Johns, S. A.,Pressler, S.(2016).Cancer, cognitive impairment, and work-related outcomes: An integrative review.Oncology Nursing Forum,43(5),602-616.
39. Wagner, L. S.,Sweet, J.,Butt, Z.,Lai, J. S.,Cella, D.(2009).Measuring patient self-reported cognitive function: Development of the Functional Assessment of Cancer Therapy–Cognitive Function Instrument.The Journal of Supportive Oncology,7(6),W32-W39.
40. Wefel, J. S.,Vardy, J.,Ahles, T.,Schagen, S. B.(2011).International cognition and cancer task force recommendations to harmonise studies of cognitive function in patients with cancer.The Lancet Oncology,12(7),703-708.
41. Zeng, Y.,Cheng, A. S.,Chan, C. C.(2016).Meta-analysis of the effects of neuropsychological interventions on cognitive function in non-central nervous system cancer survivors.Integrative Cancer Therapies,15(4),424-434.
42. Zimmer, P.,Baumann, F. T.,Oberste, M.,Wright, P.,Garthe, A.,Schenk, A.,Wolf, F.(2016).Effects of exercise interventions and physical activity behavior on cancer related cognitive impairments: A systematic review.BioMed Research International,2016,1820954.
43. 台灣癌症登記中心（2017）．存活分析－癌症五年相對存活率（僅含侵襲癌）．取自http://tcr.cph.ntu.edu.tw/uploadimages/ Survival_101_105.pdf
44. 陳仁亮,張金堅(2014)。癌症化學治療與認知功能異常。臺灣醫界，57(7)，16-18。
45. 衛生福利部（2019）．十大癌症發生率．取自https://dep.mohw.gov.tw /DOS/cp-1720-7336-113.html